Catherine Rampell: Republicans take coward's way out on health care

Tuesday

If the GOP really thinks gutting protections for people with pre-existing health conditions is good policy, they should pass a damn law.

I dare them to try.

For eight years, on and off, they did. And they failed. The House passed literally dozens of repeal bills, none of which had the chance of becoming law while Barack Obama was still president.

Then Donald Trump won the White House. Republicans had unified control of government — and they chickened out.

Why? Because they feared the blowback from voters, who had finally learned a little bit about what the Affordable Care Act actually does. While the overall Obamacare brand itself was lousy, it turned out almost all of Obamacare's major provisions were quite popular.

According to polling by the Kaiser Family Foundation, majorities of Americans in both parties liked the Medicaid expansion. They liked subsidies for lower- and moderate-income Americans buying individual insurance. They liked the elimination of out-of-pocket costs for preventive services. They liked having the federal government require insurers to cover a minimum set of benefits.

And you know what else Americans really, really liked? The bill's protections for people with pre-existing conditions.

Americans are highly motivated to support this particular provision: Most have pre-existing conditions themselves, or live in a household with someone who does. Which means they or someone they're close to could pay much higher premiums, or even lose coverage altogether.

The Kaiser Family Foundation has estimated that about 52 million Americans under the age of 65 have health conditions that would likely leave them uninsurable if they applied for individual market coverage under the underwriting practices in place in nearly every state pre-Obamacare. Most of those people might be able to get coverage through employer-sponsored plans thanks to other laws on the books, though they'd still be at risk if they lost their job-based insurance.

Angry about all the ways Republicans' repeal efforts would put health care out of reach for the poor, sick and old, Americans took action last year. They stormed town halls, flooded congressional phone lines, got arrested in acts of civil disobedience.

Spooked, Republican lawmakers decided they didn't want to be known as the party that rips insurance away from asthmatics and cancer survivors. So lawmakers simply pretended they weren't.

"Are you repealing patient protections, including for people with pre-existing conditions?" the GOP House leadership's website said in an Obamacare repeal FAQ last year. The answer: "No. Americans should never be denied coverage or charged more because of a pre-existing condition."

Trump likewise repeatedly promised to "ensure that Americans with pre-existing conditions have access to coverage."

GOP legislative proposals didn't deliver on such assurances. But in any case, the bills ultimately failed when a handful of Republican senators got cold feet about what might happen if repeal succeeded.

Unable to fully kill the ACA legislatively, Republicans turned to other, quieter ways to sabotage it. The White House has been working to expand the availability of cheap, junk insurance plans, which will siphon healthier people out of the individual insurance exchanges and lead to higher prices for the relatively sicker people who remain.

Congress also eliminated the financial penalty for not carrying health insurance, which will have the same effect.

And now the craziest sabotage scheme of all: On Thursday night, amid the Group of Seven and Singapore summit news frenzy, Trump's Justice Department urged a federal court to throw out Obamacare's protections for people with pre-existing health issues.

Twenty Republican-led states had previously brought a suit challenging Obamacare. This lawsuit argues that now that there's no financial penalty for forgoing insurance, the individual mandate is not only neutered but also unconstitutional — and therefore the law's pre-existing condition protections must be unconstitutional, too.

It's a flimsy, and convoluted, argument. It's also one that the Justice Department is legally obligated to contest. As my colleague Ruth Marcus points out, the executive branch is constitutionally required to faithfully execute the laws Congress passes, which includes defending them in court. But the Trump Justice Department is refusing to defend the case and urging the court to strike down the pre-existing condition provision.

Republican lawmakers, once hysterical over Obama's supposed "tyranny," should be apoplectic that our current president is effectively trying to undermine Congress' lawmaking authority.

Instead, most Republican lawmakers are keeping their heads down. Presumably because they know this is their best shot at destroying as much of Obamacare as possible while simultaneously dodging voters' furor for that same destruction.

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